Given AHRQ's focus on improving health outcomes and advancing methodologies in health services[unreadable] research, including cost-effectiveness analysis, the present application has three aims:[unreadable] Specific Aim # 1 (Primary Aim): Develop a content valid survey that can be used to measure highperformance[unreadable] work systems (HPWS) practices in a hospital setting.[unreadable] Specific Aim # 2: Relate HPWS practices to patient safety and quality in the healthcare industry, which will[unreadable] allow for the estimation of a) internal consistency, b) construct validity, and[unreadable] c) criterion validity. Hypothesis: The extent that HPWS practices are used in hospitals will be positively[unreadable] related to the patient safety and quality in hospitals.[unreadable] Specific Aim # 3: Determine the cost effectiveness of implementing different HPWS practices to determine[unreadable] which HPWS practices provide the most impact on patient safety and quality per dollar spent on HPWS[unreadable] practices.[unreadable] A mixed methods approach will be used for this study, including the development and administration of a[unreadable] survey that collects qualitative and quantitative information about HPWS in hospitals throughout the United[unreadable] States. The first part of the study will consist of survey development and refinement with assistance from the[unreadable] Pi's mentor (Dr. Eric Thomas) and two content experts (Dr. Cynthia St. John and Dr. Michal Tamuz). The[unreadable] second part of the study will consist of administering the survey about HPWS practices to a random sample[unreadable] of hospitals in 25 of the states in the U.S. and linking the survey responses with three criteria - Hospital[unreadable] Quality Alliance data, clinical excellence rates, and patient safety rates, where the latter two rates are[unreadable] computed using methodology developed by Health Grades Inc. that incorporates AHRQ's patient safety[unreadable] indicator framework. The third part of the study will examine the cost effectiveness of the HPWS practices[unreadable] for each of the criteria.[unreadable] The present study seeks to identify work practices used by organizations that are related to health outcomes.[unreadable] To accomplish this, the present study will look for similarities and differences in work practices used by highand[unreadable] low-performing hospitals.